TTC with Anti-Thyroid Antibodies and Hypothyroid-IUI

Dear All,
This is my very first post in this site and Im truly hoping that I can get some advice,words of encouragement and help!
I have read in the forums here how many have conceived after getting their thyroid levels stabilised within months. Its been more than a year now for me(after the thyroid diagnosis) and total of 3 yrs of TTC and 2 IUIs with injectibles,but without success
I have read that anti thyroid antibodies also can sometimes prevent the implantation from taking place. Any ladies out there who have had success with a similar history?My questions are:
1)Any medications/treatment that helped in reducing your antibodies?
2)What were the other medications given to you prior and post the IUI ?
2)Size and number of follicles on the day of trigger for IUI.
3)Estrogen and progesterone levels prior to and post IUI.
4)Do i even look at IUI or should i try for IVF?

Medical History
TSH-1.67
Tested positive for Anti thyroid antibodies and Hashimotos Thyroid
Diagnosed with mild PCOS
History of Diabetes in Family
Low estrogen level prior to IUI- 185

Re: TTC with Anti-Thyroid Antibodies and Hypothyroid-IUI

Hi
Well I have done iuis but it's been pretty long I can't help you with the I depth facts and figures relating to it. But I can let you know of one thing that thyroid doesnot affect getting pregnant. I too am a thy patient with the same .. Antibodies hypothyroid and Hasimoto thyroid since 8-9 yrs. . Just take the medicine regularly without fail and constant monitoring is required I believe in india they prescribe elthroxin or thyroxin ? Visit a good endocronologist for proper monitoring.

Re: TTC with Anti-Thyroid Antibodies and Hypothyroid-IUI

I can comment on thyroid only from experience. Hashimoto's thyroiditis makes you more likely to develop hypothyroidism in the future. This is if you do not already have developed it. Hashimoto's patients who become pregnant have to have their thyroid function tests monitored frequently. I do not think the antibodies interfere with implantation . However pregnancy can precipitate post partum thyroiditis which can become permanent hashimoto's thyroiditis. The antibodies have nothing to do with preventing pregnancy. If your ob/gyn tells you that then get a second opinion , get a new ob or get an endocrinologist.

Once you get pregnant you have to be monitored closely with treatment to keep TSH<2.5

Re: TTC with Anti-Thyroid Antibodies and Hypothyroid-IUI

Originally Posted by RamyaSridhar1978

Hi
Well I have done iuis but it's been pretty long I can't help you with the I depth facts and figures relating to it. But I can let you know of one thing that thyroid doesnot affect getting pregnant. I too am a thy patient with the same .. Antibodies hypothyroid and Hasimoto thyroid since 8-9 yrs. . Just take the medicine regularly without fail and constant monitoring is required I believe in india they prescribe elthroxin or thyroxin ? Visit a good endocronologist for proper monitoring.

Thank you Ramya!
I have been taking the medicines regularly.They do prescribe Eltroxin,but I have been taking Thyronorm. I have been visiting Dr. Prakash Pania (in Dubai,I basically live in Dubai,have been in India for the past few months for my IUIs).Hes a highly recommended endocrinologist in Dubai.Only thing his waiting period is 2 weeks. This is my last attempt at IUI before taking a 4 to 5 month break of trying naturally and shifting to IVF. My levels have stabilised now.Lets see what the future has in store for us.

Re: TTC with Anti-Thyroid Antibodies and Hypothyroid-IUI

[QUOTE=sweetnilla;2128995]I can comment on thyroid only from experience. Hashimoto's thyroiditis makes you more likely to develop hypothyroidism in the future. This is if you do not already have developed it. Hashimoto's patients who become pregnant have to have their thyroid function tests monitored frequently. I do not think the antibodies interfere with implantation . However pregnancy can precipitate post partum thyroiditis which can become permanent hashimoto's thyroiditis. The antibodies have nothing to do with preventing pregnancy. If your ob/gyn tells you that then get a second opinion , get a new ob or get an endocrinologist.

Thanks for your response!
Well this is the article that I read-

"Antithyroid Antibodies (ATA). About 50% of women who have autoantibodies to their own thyroid tissues have activated Natural Killer cells. The most common antibodies are antithyroglobulin and antimicrosomal antibodies and yet many of effected women don't have clinical signs or symptoms of reduced thyroid hormone activity (hypothyroidism). Instead, these women are often diagnosed as a result of reproductive failure manifesting as infertility, recurrent IUI and IVF failure or repeated pregnancy loss.The antithyroid antibodies (antimicrosomal and/or antithyroglobulin antibodies) do not cause the problem. They act as markers pointing to an underlying immunologic implantation problem that occurs when NKa or T-cell activation is present. The result is that as soon as the embryo starts to implant in the endometrium, "toxins" are produced (locally) that impair their ability to establish a good blood supply. In some cases, the pregnancy is lost before a blood test can detect it, while in other cases a miscarriage occurs. For unknown reasons, some pregnancies escape the "toxic gauntlet" and proceed without treatment contributing to the controversy of immunologic factors contributing to pregnancy loss and infertility.Dr. Geoffrey Sher was among the first to demonstrate that women who have reproductive failure associated with antithyroid antibodies and NKa+/T-cell activation can have successful IVF outcomes following administration of intravenous gammaglobulin (IVIG). Women who are antithyroid antibody positive but do NOT have NKa+ and or T-cell activation do not require IVIG therapy to have a successful pregnancy.IVIg therapy should be initiated prior to initiation of treatment with fertility drugs, and should be administered one more time after pregnancy is diagnosed. About 50% of women who harbor ATAs also test NKa positive. The risk of implantation failure in ATA-positive women appears to be confined to cases where ATAs coexist with NKa. IVIg therapy should be limited to such cases."My Ob/Gyn has told me that sometimes,apart from attacking the thyroid,they may also attack the embryo,so to prevent this from happening,she has prescribed omnicortil(prednisone pills) to suppress my overactive antibodies and immune system.I told her about my apprehensions regarding the steroid,but she said she was giving it in low dosages,and that it is even given to IVF patients as well for successful implantation. May I know what your course of treatment has been(if its okay with you).Have you only been taking the thyroid medicine and nothing else?Im sure lots many more with benefit with different experiences and courses of treatment.Thanks!

Re: TTC with Anti-Thyroid Antibodies and Hypothyroid-IUI

Dear Miracle magic,

I did read the article. It was not personal experience but rather clinical experience. I also want to say that i do not treat Infertility but have referred pts to and have had referrals from reproductive endocrinologists.

PURPOSE OF REVIEW: Much attention has been paid to the role of immunology in reproductive success or failure. Every step in the establishment of normal pregnancy has been implicated as a possible site of immune-mediated reproductive failure. The widespread testing of antiphospholipid, antinuclear, antithyroid, and antisperm antibodies, as well as generalized immune testing, have thus been employed to diagnose patients with otherwise unexplained infertility or recurrent pregnancy loss. Controversial data surrounding the widespread and variable use of immune testing in current fertility practice is reviewed to determine which tests are warranted based on sound scientific evidence. RECENT FINDINGS: Despite the increased prevalence of abnormal immune testing associated with early reproductive failure, the most rigorous studies have not proven a cause and effect SUMMARY: Great variability exists in identifying candidates for immune testing, determining which tests to order, interpreting the test results, and offering immunologic treatments. This review argues that the use of widespread immune testing in clinical practice can not be supported by existing data. The resulting therapies are similarly of unconfirmed benefit and may cause harm.

I agree that women with auto-immune diseases are at risk for infertility. Like the article you quoted says the anti-thyroid antibodies do not interfere with implantation but have been associated in some studies with recurrent miscarriages/placental abruptions. AntiPl and anti cardiolipin are associated with both infertlity and miscarriages. But you must know that they may be a harbinger for other AI diseases-Polyglandular Autoimune diseases, Autoimmune oophoritis, celiac disease.

So in conclusion:

1.Anti-thyroid antibodies may indicate presence of other autoimmune diseases
2.Anti-thyroid antibodies do not prevent implantation and we do not treat these patients unless they become hypothyroid. I usually get pts who are pregnant and are antibody positive. We monitor and do not treat.
3.Anti-thyroid antibodies however may make you more resistant to medicines like Clomiphene citrate and Metformin that are used in PCOS.
4.You are appropriately treated with thyroid hormone to keep your TSH in pregnancy specific ranges. There are trimester specific TSH ranges.
5.Prednisone is used in treating autoimmune diseases and It reduces autoimmunity of any kind. I do not use prednisone to treat hashimoto's since I am not an reproductive endocrinologist I do know of a study with 100 pts done some years ago where prednsione treatment increased conception rates. I will send you the link as soon as possible.

Re: TTC with Anti-Thyroid Antibodies and Hypothyroid-IUI

Dear Sweet Nilla,

Thank you so much for your response. It was very informative. I had no idea that the ATAs make you more resistant to medicines like clomiphene citrate and metformin. I have tried to go through so many forums to get a clearer idea about thyroid and antibodies,but nowhere has it been discussed from this angle,and Im always left wondering as to what could be causing my infertility....and quite frankly,all this antibody talk is a little confusing for a layman like me

Its nice to read abt the survey reg prednisone and the conception rates for 100 pts..it gives me hope...

Re: TTC with Anti-Thyroid Antibodies and Hypothyroid-IUI

Hi MM,

I was diagnosed with hypothyroidism in 2009...I have been taking Eltroxin 25mg since then...we did have some fertility issues but they were not related to thyroid. Happy to tell you that I conceived naturally and am expecting my baby in August. So don't let this get to you. Just take your medication without fail everyday...I have not even checked my thyroid levels in over 8 months, so I have no clue if it is up or down! Just wanted to let you know that having a thyroid condition does not mean you will have difficulty getting pregnant. As long as you keep it within normal levels it should be fine. Good luck!

Re: TTC with Anti-Thyroid Antibodies and Hypothyroid-IUI

Dear Cj,
Firstly heartiest congratulations on your pregnancy! Regarding my thyroid,it took me some 8 odd months for my levels to stabilise and to figure out my correct dosage.It kept fluctuating from hypo to hyper..Im on 75mcg of Thyronorm and that seems to be suiting me just fine now.Have had 2 IUI's since dec last year but both were unsuccessful. It does give me hope to know that you conceived naturally!

Also,I must share that my post coital test(PCT) showed 0% motile sperms,so none of them seem to be swimming through my CM. That is the reason we opted for IUI thinking that this may place the sperms closer to the tubes as they bypass the cervix.Otherwise my DH's count and motility are fine.This was something that really bothered me as I thought that we would never be able to conceive naturally becoz of hostile CM,but my doc seemed very confident in assuring me that she has come across many patients who have concieved even after such results in the PCT.So yet another ray of hope,for us to try naturally.

This month is my last shot for IUI. Doing it only with injectibles this time and not Clomid.And then we try naturally for 5 months.

Praying for a BFP this year...!

P.S...you said that you did not check your TSH for the past eight months.I hope you're getting them checked now!All the very best for a safe and happy pregnancy!

You will be fine. Ask questions to your ob/gyn/reprospecialist/endocrinologist. Dont feel bad about getting a second opinion. Any suggestion from your docs that worries you-politely sweetly ask questions. As a patient it is the duty of your doctor to make you understand about every stap that is planned. That is your right. Good luck and hope to hear good news from you soon.